Mental Health Services/Teams in the Community

Mental health services are
undergoing a great deal of change and development at
present.In many areas, the traditional
Community Mental Health Team is being re-structured into new
specialist teams. Information on the new service teams should be
available from your local NHS mental health trust.

Introduction

This leaflet is for anyone who has been
referred to a mental health service/team in the
community - and for their friends and family. It describes why
we have mental health services/teams in the community, how they
work, who works in them and what they do. The information here is most
relevant for the UK. These services exist in other
countries, but may be organised in different ways.

Why do we have mental health services in the
community?

Most mental health problems don't need a
psychiatrist. Your GP can give you support, prescribe
antidepressants or refer you to a counsellor or psychotherapist.
However, if your problems are more complicated, your GP may want to
refer you to a mental health service or team in the
community.

Many things can cause mental health problems
- physical or mental illness, past experiences, difficult
relationships, drug and alcohol problems or stresses like
unemployment. Relationships can become difficult and you may find
it harder to deal with the various problems of life. So - you
may need help with a number of different areas to get over a mental
health problem, including:

emotional problems

relationship problems

housing

medicines

money and benefits

work, or something rewarding and useful to
do

getting back your self-confidence.

No one, however well trained, can do all
these things well. So, mental health professionals work in
teams, usually of between 8 to 16 people. Each team has
several types of workers with different knowledge and skills. They
will each understand how the others work and will understand how to
tackle problems together.

Who might you meet in a mental health team in the
community?

In many areas of the UK, you will most often
see a mental health worker. They can be
from a number of different professional backgrounds (see below) but
will all aim to develop a trusting, respectful and helpful
relationship with you.

They can help by:

working with you to keep an eye on any
changes in your behaviour, feelings and thinking

being someone to talk to

developing your strengths

working to find answers to your current
problems

helping you to become more
independent.

You may be seen on your own, in a group with
other people or, sometimes, with your friends or family. Mental
health workers share a number of important skills, but
can also use their more specialist professional skills when
needed. These professions include:

Psychiatrist

A psychiatrist is a medical
doctor with special training in mental illnesses and emotional
problems. Each team has a consultant who has completed their
professional training. If you need to take medication, they will be
responsible for arranging this. They may also have trained in
psychotherapy. There may also be an “associate specialist” or
“staff grade” doctor, who will have trained in psychiatry but who
has not become a consultant. They often work with a doctor doing
further training in psychiatry – a “specialty trainee” or
“specialist registrar”. See our leaflet on 'Psychiatrists: what to expect'

Community Psychiatric Nurse (CPN)

CPNs work outside hospitals and visit
clients in their own homes, out-patient departments or GP
surgeries. They can help you to talk through problems and give
practical advice and support. They can also give medicines and keep
an eye on their effects. Nurse therapists have had extra training
in particular problems and treatments, such as eating disorders or
behaviour therapy.

Social Worker

Like other members of the team, social
workers help people to talk through their problems, give them
practical advice and emotional support and provide some
psychological treatments. They are able to give expert
practical help with money, housing problems and other
entitlements.

Occupational Therapist (OT)

Occupational therapists help people to get
back to doing the practical things of everyday life. They may help
you:

to work out what you can and cannot do

with advice on where you could or should
live

to find things to do that you want to
do

to re-build your confidence

to become independent.

This can be through doing practical things
in a relaxed environment, or talking with other people in
groups.

Clinical Psychologist

Clinical psychologists have a degree in
psychology. During another 3 years training in clinical
psychology they work with clients and learn how to give
psychological treatments. They will usually meet regularly with you
for a number of sessions to talk through how you are feeling,
thinking and behaving. Although cognitive
behavioural therapy is a common approach, clinical
psychologists may use psychodynamic and behavioural
psychotherapies. They also help other members of the team to work
psychologically with their clients.

Pharmacist

Pharmacists train for five years to become
specialists in medicines. They can give expert advice to doctors
and nurses and talk to patients and carers about medications.

Other staff

The Team Manager

The team manager will usually be a
senior nurse or social worker. They often do not see clients
themselves. They are responsible for:

the practical details of running the
team

how the team works with other parts of the
health service and other organisations

helping the team to develop

making sure that the team has high
standards of practice.

Approved Mental Health Professional

The Approved
Mental Health Professional will usually be a social worker, but
can be any member of the team. They have had further training for
assessing if someone needs to be taken to hospital using the Mental
Health Act. They cannot decide to admit someone to hospital on
their own, but will usually need the agreement of 2 independent
doctors.

Receptionists and
secretaries

In a way, every person who works in a
hospital unit, day centre, or hostel is a member of the team.
Receptionists and secretaries make the team run smoothly and are
responsible for much of the atmosphere of the service. You may find
that you get to know them quite well. However, they are not usually
involved in any decisions about your care.

Other staff who work directly with
clients

These can include outreach workers, mental
health workers, benefits workers, support workers, recovery
workers, vocational therapists, arts therapists and
psychotherapists. More and more, staff without a professional
qualification are also working with such teams because of their
special knowledge and skills. These include people who have had
mental health problems, advocates, and workers from day centres or
housing organisations. Specialist old age psychiatry teams may
include other professionals such as speech therapists or
physiotherapists. These workers may also see people in their own
homes.

How does the team
work?

Where does it work?

The team may have a base, like a clinic, where they can see
clients. They will also work in a whole range of other places -
out-patient clinics, GP surgeries, day-centres, hostels and
people's own homes.

Team working

Working with you

All the team members will understand the
distress that goes with mental illness. They can all offer
psychological support, encouragement and practical help.

Working together

At regular team meetings, staff discuss how
best to help their clients. They try to make sure that they have a
clear picture of your difficulties and strengths. They can then
plan the right help with you. Staff work closely together and learn
a lot from each other. You may find that nurses can deal with many
social problems and that occupational therapists and social workers
know something about medication. This also means that, if your
key worker is away, there will usually be someone
around who knows something about you.

Will I meet the whole team?

You won't have to see the whole team, although you may see one
or two different people at first. The team will then decide who
should work with you. You will usually see just one person at a
time.

The key worker/care coordinator

One of the team members would usually be your key worker – it
is often a social worker or nurse. This should be a helpful
and supportive partnership. Your key worker should:

get to know you

learn about your difficulties

find out how you see your problems

know about your strengths

discuss any plans with you

give counselling, information and
advice

make sure that everybody is working
together properly

make sure that you have a clear
“care plan” about how you are going to be
helped.

Care plan

The different parts of your help or
treatment are written down in the care plan. This should
include:

the problem (or problems)

any risks involved

your strengths

what needs to be done to help you
recover

who should be doing what

your views – you should have a copy.

If you need to see the team for a while, you
may be put on the Care Programme Approach (CPA). This means that
there is a meeting every few months with everyone who is involved
in your care plan. You should be invited to this meeting, but
you don't have to come if it makes you too anxious.

What if I don't get on with my key
worker?

If you can tell your key worker what the problem is, you may be
able to sort it out together. If you can't do this, you will need
to talk to the team manager. If they can't sort out the
problem, you may need a different key worker.

What about confidentiality?

Members of a mental health team have to keep your
information confidential in the same way as other doctors and
health-care staff. But

They will share information about you with
other members of the team so that they can give you the best
possible care.

They will not usually give information to
people outside the team without your permission.

They will need to be able to talk to your
GP and any other doctors whom you are seeing.

Secretaries and receptionists do not have
access to most of the information that the professional staff do,
but will know some details about you.

If you are worried about confidentiality,
check it out with one of the team - so you can be clear about who
knows what, and why they need to.

Can relatives and friends become
involved?

Families and carers are usually concerned and want to help.
Families often need support and encouragement. Many teams provide
information for families and hold regular support
groups. A mental health team may want a family to be
involved, but are still bound by medical confidentiality. So, they
will usually ask your permission to give information about you to
your family. At the same time, families have to live and cope
every day with problems. A mental health team should ask
you about what you are happy for your family to know, and what you
do not want discussed with them. For further information on carers
issues, see the information produced by the
College's Partners in Care campaign.

What about advocates?

An advocate can help you to ask questions
and get your message across to professionals. He or she can go to
meetings with you. They are not usually part of the mental health
team, but will be employed by a voluntary organisation or another
part of the health service.

Will I be offered the choice of pills or
counselling?

This will depend both on what
the team thinks would be most helpful and on what you would prefer.
It isn't usually a simple choice of either pills or counselling.
Most people need the chance to talk though their problems and feel
understood, and most staff have counselling skills of varying
degrees. Sometimes there may be a worker, often a clinical
psychologist who does just counselling or psychotherapy. Many
people get help from both medication and talking treatments.

How does my GP fit in?

Mental health teams and GPs should work
closely together. After the staff have seen you, they
will send your GP a letter to tell him or her about their
assessment of your problems and what they suggest should be done.
Your GP will often prescribe regular medications for you. Unless
you are admitted to hospital, your GP remains responsible for the
rest of your medical care. If you are admitted to hospital, your GP
will be kept informed of your progress and the discharge plan. When
you are in hospital, the psychiatrist will be responsible for your
medical care.

What if I have a problem with a mental health service
in the community?

If you cannot sort the issue out with the
member of staff involved, contact the team manager. If you are not
happy with what they say, you can make an official
complaint to the health trust, Community Health Partnership or
Health Board (depending on where you live in the
UK) which is responsible for that particular team. All trusts
should have a clear way of dealing with complaints.

Specialist CMHTs

In the UK, there is now a range of more
specialist services in the community, including:

Home treatment

Crisis intervention

Early onset psychosis

First episode psychosis

ABT (assessment and brief treatment)

Continuing care

Rehabilitation

Assertive Outreach

Forensic

They share most of the features described
above, but deal with a particular set of problems.

What can I expect in my area?

Teams in different areas may be quite
different. Some mental health teams concentrate on helping people
who have severe and long-lasting mental illness. They may not be
able to provide much in the way of counselling services for people
with less severe depression or anxiety problems. If you are
not happy with the services available, your Independent Complaints
Advocacy Service (in Wales, the Community Health Council) may
be able to take it up with the local Health Authority.

This factsheet was produced by the RCPsych's Public Education
Editorial Board.